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        <p><strong>第七章 超声牙周治疗的模块(Ultrasonic instrumentation techinque modules)</strong><br>用一种系统的方法或步骤来实施上一章所阐述的原则。<br>一、治疗顺序的策略(Strategies for instrumentation sequecing)<br>①分象限进行工作(work by sextant)<br>将全口分为六个区域，上下颌分别有两侧后牙和前牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/01.png"><br>如此划分治疗区域，降低了改变姿势和工具的频率，从而能更有效的完成治疗。<br>对于较厚的牙石，比如初次治疗的患者，仔细的设计治疗区域能避免在治疗过程中反复更换工作尖。（意思是，原来四个象限，每个象限都有前牙和后牙，因此在过渡的时候都要更换器械，而分成六个区域，在区域内就不用换器械了。这种方法是比较好，手工刮治也可以用？）<br>②面向操作者(Advance toward operator)<br>(这段较难翻，我用自己的话解释下吧：就是治疗的顺序应该是逐渐接近操作者，如右侧后牙应该按照7-4的顺序，左侧后牙也是7-4的顺序，而不是4-7逐渐远离操作者。）在前牙区域，左利手操作者的顺序是相反的。<br>③贴合的位点(Points of adaptation)<br>跟手工刮治一样，在前牙的贴合位点是中线区域。在后牙为颊舌侧的线角区域。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/02.png"><br>不像手工器械那样每颗牙都要像这样贴合，超声器械只在该治疗区域第一颗牙的时候进行贴合，以启动治疗程序。<br>④过渡以前进(Advance by transitioning)<br>有四种过渡方式。<br>工作尖的背部贴合近中牙面，以进行倾斜用力方式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/03.png"><br>工作尖的侧面垂直贴合远中牙面，倾斜用力方式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/04.png"><br>工作尖的表面（face）水平贴合牙冠的远中面，垂直用力模式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/05.png"><br>工作尖的背部水平贴合牙冠的近中牙面，垂直用力模式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/06.png"><br>邻面区域的转移：对于邻面区域（或颈部区域），工作尖从垂直模式转换到水平模式以保持器械与牙面的贴合，采用一种轻微旋转的运动方式。<br>⑤转移到下一颗牙齿上<br>从一颗牙的近中牙面迁移到下一颗牙的治疗区域，可以通过保持水平向移动，将工作尖的表面(face) 贴合于邻牙的远中来实现，在邻牙远中采用垂直运动模式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/07.png"><br>从邻接区域移出：在移出过程中，工作尖从水平状态通过轻微翻转运动变换到垂直状态，同时与牙齿保持贴合，工作尖的侧面与牙齿的远中面相贴合。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/08.png"><br>与进入邻接区域一样，要避免旋转工作尖时工作尖对釉质直接相对产生的刨削作用。工作尖随后进入龈下，倾斜运动方式覆盖远中根面，然后进入远中线角。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/09.png"><br>下面具体分为前牙模块(anterior sextant）和后牙模块(posterior sextant)介绍基本的超声清创步骤。<br>(以下全部只写右利手医生的情况，左利手的情况略过）<br><strong>模块1：前牙区域：下颌前牙舌侧(Anterior Sextant: Mandibular Anterior Lingual)</strong><br>医生体位<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/10.png"><br>从离医生最远的牙位开始：33号牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/11.png"><br>将工作尖工作区的侧面与患牙中线垂直贴合。采用水平运动方式使工作尖进入龈下，以及远中线角区域。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/12.png"><br>随着工作尖通过远中舌侧线角，将工作尖侧面保持与远中牙面贴合并转移到远中根面。使用水平或轻微倾斜的用力方式进入龈下和颊侧，直到遇到接触点的阻挡。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/13.png"><br>通过水平贴合工作尖的表面与33的远中牙面，转移到远中邻面空间，垂直用力。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/14.png"><br>通过恢复工作尖侧面与牙面的垂直贴合，移出远中邻面区域，工作尖回到远舌线角区域。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/15.png"><br>经过远舌线角，在龈下水平移动工作尖，往近中通过舌侧，靠近近中线角。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/16.png"><br>当工作尖通过近舌线角时，用工作尖背面贴合近中根面，转移到近中牙面。在龈下向颊侧前进，使用水平或稍微倾斜的用力方式，直到被接触点阻挡。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/17.png"><br>转移到近中邻面区域，通过保持工作尖背部与33的近中牙冠相贴合，翻转进入水平贴合，相对近中牙面垂直运动。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/18.png"><br>通过将工作尖的表面贴合于32的远中，转移到邻牙。垂直相对32的近中牙面用力。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/19.png"><br>从远中邻面转移到工作尖的侧面垂直贴合。在舌侧龈下前进，使用水平或轻微倾斜的力量。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/20.png"><br>通过32的远中舌侧线角，以水平用力方式在龈下前进，朝向近中舌侧线角。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/21.png"><br>在工作尖通过近中舌侧线角时，保持工作尖背面与患牙近中根面垂直贴合，使用水平或倾斜的用力，在龈下向颊侧运动直到遇到接触点的阻挡。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/22.png"><br>在接触点，转变成工作尖背部的水平贴合，相对近中牙面，垂直运动。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/23.png"><br>进入到31，保持工作尖的表面与31远中水平贴合，相对远中牙面垂直用力。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/24.png"><br>使工作尖侧面与远中牙面垂直贴合，水平或倾斜用力，工作尖在龈下和舌侧朝向远中舌侧线角移动。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/25.png"><br>通过远舌线角直到整个区域（直到43）的远中牙面治疗完成。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/26.png"><br>(模块总结：从原离医生的牙位开始，从中央线角处开始贴合，垂直贴合，水平移动，到远中线角后，变成水平贴合，垂直移动，然后再恢复垂直贴合，水平移动到近中，再换成水平贴合，垂直移动。然后前进到下一颗牙。脑海里要有整个运动的影像。）</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。<br><strong>我被“举报”有诱导用户点击的行为了，呵呵，真是见识了，就像吃了一只苍蝇那样恶心。希望举报我的用户自行取消关注，谢谢！</strong><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0130-csyzzl08/27.png"></p>
<p>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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